Need help with appeal letter to BCBS Michigan

[Cautious2010 0]

Hello all!

I've been approved by BCBS Michigan for a bypass. My BMI was 40 when the paperwork was submitted, but is now 43. I am not comfortable with the bypass procedure and would like to get the sleeve. I have been denied the sleeve procedure and am filling a patient appeal. My surgeon will not write a letter on my behalf because I do not have particular co-morbidities.

Do any insurance companies cover the sleeve as a stand alone procedure for my BMI? Does anyone know how close (or not) we are to insurance companies covering it? Have any of you been successful in this type of appeal to your insurance co?

Thanks!

[avilda 2]

Aetna and UHC cover the sleeve as a stand alone for BMI 40+. I don't know about others.

[Tiffykins 673]

Here are some links of appeal letters and stories to help guide you in getting your appeal letter together.

One common thing that a lot of appeals are won on is the fact that we can take NSAIDS. RNY patients can not due to the ulcer issue.

These appeal letters already have all the research links and articles cited within them. So you may have to copy and paste, change the wording around to fit your specific needs, but these are some pretty awesome letters.

Some of these patients have won some of them have not been able to.

The Diary of a Fat Woman: Deny Deny Deny!

http://verticalsleevetalk.com/pre-operation-vertical-sleeve-surgery-vsg-questions-answers/1751-unapproved-sleeve-ready-cry-2.html#post17480

vsgappeal: Appeal Letter

http://verticalsleevetalk.com/insurance-financing/1496-my-appeal-draft-w-references.html#post14133

ObesityHelp.com - Insurance trouble

Here is the most recent updated statement from the ASMBS on the VSG.

http://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf

Page 5 has some amazing articles for further research to help you with your appeal letter.

I personally did not have to deal with this, but I try to give people dealing with appeals the information I've gathered over the last year or so.

[Cautious2010 0]

Thank you Avilda and Tiffykins for the info. I am writing my letter this weekend, so your fast post is wonderful!

[ZenBunni 0]

I am currently putting on my boxing gloves with BCBS, so these are very helpful. THANKS!

Stefanie

[Eydiebug 0]

When was the last time that you checked with BCBS? They have made some changes to their policies, and many are now covering VSG. I have BCBS of TX, and when I checked back in June '10, they only covered gastric banding and RnY. But, as of July 1, 2010, they now cover all of the surgeries, including the sleeve. Try giving them a call, if you haven't already.

Eydie :thumbup:

[sleevegenie 0]

I won my appeal with Anthem Blue cross if you belong to Obesity help you can look at my letter on my profile page, same name on that site as this, good luck to you jeani

[ZenBunni 0]

Thanks Jeani, I did get your letter. That and other letters are a big help in compiling the info.

Eydie, I have BCBS of CA. I got my denial at the end of August. As I understand they are one of the last holdouts of the blue cross families. So I am sure as Murphy's law goes, as soon as I send all this in they will change their coverage policies LOL - :laugh0:

Thanks everyone! :001_tt2:

[ShellieB73 0]

Wellmark - BCBS in Iowa isn't covering yet either, but they are due to revise their policy this month.....I am patiently (not) waiting.....and stalking the website daily!!!!!

[mp8btpc 33]

Here are some links of appeal letters and stories to help guide you in getting your appeal letter together.

One common thing that a lot of appeals are won on is the fact that we can take NSAIDS. RNY patients can not due to the ulcer issue.

These appeal letters already have all the research links and articles cited within them. So you may have to copy and paste, change the wording around to fit your specific needs, but these are some pretty awesome letters.

Some of these patients have won some of them have not been able to.

The Diary of a Fat Woman: Deny Deny Deny!

http://verticalsleevetalk.com/pre-operation-vertical-sleeve-surgery-vsg-questions-answers/1751-unapproved-sleeve-ready-cry-2.html#post17480

vsgappeal: Appeal Letter

http://verticalsleevetalk.com/insurance-financing/1496-my-appeal-draft-w-references.html#post14133

ObesityHelp.com - Insurance trouble

Here is the most recent updated statement from the ASMBS on the VSG.

http://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf

Page 5 has some amazing articles for further research to help you with your appeal letter.

I personally did not have to deal with this, but I try to give people dealing with appeals the information I've gathered over the last year or so.

Tiffy- Girl you must be one organized cookie. You have so much info and it all seems to be organized and thoughtful. Seriously, I tried to remember where I read something about ghrelin today...I couldn't even find the damn thing lol.

I think they should start paying you on this website.